Journal List > J Korean Ophthalmol Soc > v.53(10) > 1009186

TOOLS
Jang, Kim, and Suh: The Efficacy of Preoperative Routine Otorhinolaryngologic Referral Before Endonasal Dacryocystorhinostomy
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(10): 1392-1396.

Published online: 17 October 2012

DOI: https://doi.org/10.3341/jkos.2012.53.10.1392

The Efficacy of Preoperative Routine Otorhinolaryngologic Referral Before Endonasal Dacryocystorhinostomy

Young Jun Jang, MD, Ho Chang Kim, MD, PhD, Eok Soo Suh, MD

Department of Ophthalmology, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju, Korea.

Address reprint requests to Ho Chang Kim, MD, PhD. Department of Ophthalmology, Dongguk University Gyeongju Hospital, #87 Dongdae-ro, Gyeongju 780-350, Korea. Tel: 82-54-770-8256, Fax: 82-54-772-9618, ophho@hanmail.net

Received 16 March 2012       Accepted 12 August 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

To determine if routine otorhinolaryngologic referral prior to endonasal dacryocystorhinostomy (EN-DCR) is necessary.

Methods

Two hundred thirty-seven eyes of 178 patients who were supposed to undergo EN-DCR were prospectively analyzed. Nasal endoscopy was performed by an ophthalmologist and the patients who had severe abnormality were referred to an otorhinolaryngologist. The patients were classified into 3 groups after a preoperative examination by an ophthalmologist and an otorhinolaryngologist; the number and success rate of each group were then investigated. Group A consisted of patients who had no nasal cavity abnormality, Group B consisted of patients with a nasal cavity abnormality but who received no treatment, and Group C consisted of patients who had a nasal cavity abnormality and received otorhinolaryngologic treatment.

Results

The number of subjects in each group was 156 in Group A (87.7%), 12 in Group B (6.7%), and 10 in Group C (5.6%). The number of patients who were referred to the otorhinolaryngologist was 22 (12.3%). There was no statistical significance of success rate between the groups.

Conclusions

Routine nasal endoscopic examination should be performed by an ophthalmologist prior to EN-DCR. Only patients with severe abnormal findings should be referred to an otorhinolaryngologist as the results from the present study show the percentage of patients having significant nasal abnormalities was found to be low (12%) and the success rate of EN-DCR revealed no statistical significance between the groups. This could help patients by saving time and expense.

Keywords: Endonasal dacryocystorhinostomy (EN-DCR), Nasal abnormality, Nasal endoscopy, Otorhinolaryngologist, Referral

Figures and Tables

Figure 1
Study flow chart. DCR = dacryocystorhinostomy.
jkos-53-1392-g001
Table 1
Pre-operative nasal endoscopic findings (n = 178)
jkos-53-1392-i001
Table 2
The success rate of group A, B, and C at 12 months after endonasal dacryocystorhinostomy (n = 237)*
jkos-53-1392-i002

Values are presented as number (%).

*p-value between Group A and Group B, C by Fisher's exact test. p = 0.146; †Group A: no sinonasal abnormality in pre-operative examination by Ophthalmologist; ‡Group B: sinonasal abnormality which was not corrected by Otorhinolaryngologist; §Group C: sinonasal abnormality which was corrected by Otorhinolaryngologist.

References

1. Gu BY, Kim WJ, Son JH. Learning curve for endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2011. 52:519–523.
2. Rose GE. The lacrimal paradox: toward a greater understanding of success in lacrimal surgery. Ophthal Plast Reconstr Surg. 2004. 20:262–265.
3. Kim JM, Hong WP, Choi YJ, Kim SJ. The effect of nasal cavity abnormality related to surgical success rate of endonasal dacryocystorhinostomy. J Korean Ophthalmol Soc. 2006. 47:1233–1237.
4. Durvasula VS, Gatland DJ. Endoscopic dacrocystorhinostomy: long-term results and evolution of surgical technique. J Laryngol Otol. 2004. 118:628–632.
5. Lee YJ, Moon SW, Cho HY, Jeong JH. Clinical outcome of dacryocystorhinostomy with septal deviation. J Korean Ophthalmol Soc. 2008. 49:713–720.
6. Eyigör H, Unsal AI, Unsal A. The role of accompanying sinonasal abnormalities in the outcome of endonasal dacryocystorhinostomy. Am J Rhinol. 2006. 20:620–624.
7. Wormald PJ. Powered endoscopic dacryocystorhinostomy. Otolaryngol Clin North Am. 2006. 39:539–549.
8. Lee NS, Jun BC, Cho HJ, Yoon HR. The clinical study of endoscopic dacryocystorhinostomy. Korean J Otolaryngol-Head Neck Surg. 1999. 42:68–71.
9. Kallman JE, Foster JA, Wulc AE, et al. Computed tomography in lacrimal outflow obstruction. Ophthalmology. 1997. 104:676–682.
10. Nussbaumer M, Schreiber S, Yung MW, et al. Concomitant nasal procedures in endoscopic dacryocystorhinostomy. J Laryngol Otol. 2004. 118:267–269.
11. Fayet B, Racy E, Assouline M. Systematic unciformectomy for a standardized endonasal dacryocystorhinostomy. Ophthalmology. 2002. 109:530–536.
12. Smirnov G, Tuomilehto H, Kokki H, et al. Symptom score questionnaire for nasolacrimal duct obstruction in adults--a novel tool to assess the outcome after endoscopic dacryocystorhinostomy. Rhinology. 2010. 48:446–451.
13. Fayers T, Laverde T, Tay E, Olver JM. Lacrimal surgery success after external dacryocystorhinostomy: Functional and anatomical results using strict outcome criteria. Ophthal Plast Reconstr Surg. 2009. 25:472–475.
14. Zenk J, Karatzanis AD, Psychogios G, et al. Long-term results of endonasal dacryocystorhinostomy. Eur Arch Otorhinolaryngol. 2009. 266:1733–1738.
15. Gökçek A, Argin MA, Altintas AK. Comparison of failed and successful dacryocystorhinostomy by using computed tomographic dacryocystography findings. Eur J Ophthalmol. 2005. 15:523–529.
16. Elmorsy SM, Fayk HM. Nasal endoscopic assessment of failure after external dacryocystorhinostomy. Orbit. 2010. 29:197–201.
17. Korkut AY, Teker AM, Yazici MZ, et al. Surgical outcomes of primary and revision endoscopic dacryocystorhinostomy. J Craniofac Surg. 2010. 21:1706–1708.
18. Choussy O, Retout A, Marie JP, et al. Endoscopic revision of external dacryocystorhinostomy failure. Rhinology. 2010. 48:104–107.
19. Konuk O, Kurtulmusoglu M, Knatova Z, Unal M. Unsuccessful lacrimal surgery: Causative factors and results of surgical management in a tertiary referral center. Ophthalmologica. 2010. 224:361–366.
20. Soyka MB, Treumann T, Schlegel CT. The Agger Nasi cell and uncinate process, the keys to proper access to the nasolacrimal drainage system. Rhinology. 2010. 48:364–367.
21. Cheng AC, Wong AC, Sze AM, Yuen HK. Limited nasal septoplasty by ophthalmologists during endonasal dacryocystorhinostomy: Is it safe? Ophthal Plast Reconstr Surg. 2009. 25:293–295.
22. Lee TS, Shin HH, Hwang SJ, Baek SH. The results of revisional surgery for the failed endonasal DCR. J Korean Ophthalmol Soc. 2007. 48:186–192.
23. Francis IC, Kappagoda MB, Cole IE, et al. Computed tomography of the lacrimal drainage system: retrospective study of 107 cases of dacryostenosis. Ophthal Plast Reconstr Surg. 1999. 15:217–226.
24. Savino G, Messina L, Colucci D, et al. Surgical treatment of obstruction of the nasolacrimal ducts in patients with anatomical endonasal variants. Scand J Plast Reconstr Surg Hand Surg. 2007. 41:10–13.
25. Metson R. Endoscopic surgery for lacrimal obstruction. Otolaryngol Head Neck Surg. 1991. 104:473–479.
26. Iliff CE. A simplified dacryocystorhinostomy. 1954-1970. Arch Ophthalmol. 1971. 85:586–591.
27. Singh M, Jain V, Singh SP, Gupta SC. Endoscopic dacryocystorhinostomy in cases of dacryocystitis due to atrophic rhinitis. J Laryngol Otol. 2004. 118:426–428.
TOOLS
Similar articles